Download PDF
J Wrist Surg 2015; 04(04): 278-283
DOI: 10.1055/s-0035-1564983
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Missed Scaphoid Fracture–Outcomes of Delayed Cast Treatment

Ruby Grewal
1   Division of Orthopedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Center, London, Ontario, Canada
,
Nina Suh
1   Division of Orthopedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Center, London, Ontario, Canada
,
Joy C. MacDermid
1   Division of Orthopedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Center, London, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
29 October 2015 (online)

    Permissions and Reprints

Abstract

Background The purpose of this study is to evaluate outcomes (report union rates and times based on CT) for subacute scaphoid fractures, defined as those presenting between 6 weeks and 6 months from injury.

Questions 1) What are the expected union rates for subacute scaphoid fractures? 2) What are the expected union times for subacute scaphoid fractures? 3) Is it worth trialing a period of cast immobilization for these patients?

Methods All isolated sub-acute scaphoid fractures that presented at our institution between 2006 and 2010 were identified. Each subject's health record, CT scans and X-rays were retrospectively reviewed.

Results There were 20 males and 8 females, with a mean age of 30, treated with casting alone. There were 20 waist, 7 proximal and 1 distal pole fracture. The mean casting time was 11 (waist) and 14 (proximal pole) weeks with a union rate of 82% (23/28). Diabetes, comminution and a humpback deformity increased the non-union risk in this cohort. Exclusion of these cases resulted in a 96% union rate (23/24).

Conclusion Subacute scaphoid fractures (presenting within 6 months from injury) can be expected to successfully heal with casting alone, even if the initial diagnosis is delayed. The expected time frame for union with cast treatment is shorter than previously reported.

Level of Evidence IV.

Keywords

scaphoid fracture - union - subacute scaphoid fracture - missed scaphoid fracture - computerized tomography - treatment delay
 

  • References

  • 1 Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res 1980; (149) 90-97
    PubMedGoogle Scholar
  • 2 Langhoff O, Andersen JL. Consequences of late immobilization of scaphoid fractures. J Hand Surg [Br] 1988; 13 (1) 77-79
    CrossrefPubMedGoogle Scholar
  • 3 Mack GR, Wilckens JH, McPherson SA. Subacute scaphoid fractures. A closer look at closed treatment. Am J Sports Med 1998; 26 (1) 56-58
    PubMedGoogle Scholar
  • 4 Dias JJ, Taylor M, Thompson J, Brenkel IJ, Gregg PJ. Radiographic signs of union of scaphoid fractures. An analysis of inter-observer agreement and reproducibility. J Bone Joint Surg Br 1988; 70 (2) 299-301
    PubMedGoogle Scholar
  • 5 Chen AC, Lee MS, Ueng SW, Chen WJ. Management of late-diagnosed scaphoid fractures. Injury 2010; 41 (6) e10-e14
    CrossrefPubMedGoogle Scholar
  • 6 Inaparthy PK, Nicholl JE. Treatment of delayed/nonunion of scaphoid waist with Synthes cannulated scaphoid screw and bone graft. Hand (NY) 2008; 3 (4) 292-296
    CrossrefPubMedGoogle Scholar
  • 7 Bain GI, Bennett JD, Richards RS, Slethaug GP, Roth JH. Longitudinal computed tomography of the scaphoid: a new technique. Skeletal Radiol 1995; 24 (4) 271-273
    PubMedGoogle Scholar
  • 8 Singh HP, Forward D, Davis TR, Dawson JS, Oni JA, Downing ND. Partial union of acute scaphoid fractures. J Hand Surg [Br] 2005; 30 (5) 440-445
    CrossrefPubMedGoogle Scholar
  • 9 Hackney LA, Dodds SD. Assessment of scaphoid fracture healing. Curr Rev Musculoskelet Med 2011; 4 (1) 16-22
    CrossrefPubMedGoogle Scholar
  • 10 Grewal R, Suh N, Macdermid JC. Use of computed tomography to predict union and time to union in acute scaphoid fractures treated nonoperatively. J Hand Surg Am 2013; 38 (5) 872-877
    CrossrefPubMedGoogle Scholar
  • 11 Wong K, von Schroeder HP. Delays and poor management of scaphoid fractures: factors contributing to nonunion. J Hand Surg Am 2011; 36 (9) 1471-1474
    CrossrefPubMedGoogle Scholar
  • 12 Eddeland A, Eiken O, Hellgren E, Ohlsson NM. Fractures of the scaphoid. Scand J Plast Reconstr Surg 1975; 9 (3) 234-239
    CrossrefPubMedGoogle Scholar
  • 13 Lozano-Calderón S, Blazar P, Zurakowski D, Lee SG, Ring D. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg Am 2006; 88 (12) 2695-2703
    CrossrefPubMedGoogle Scholar
  • 14 Bain GI. Clinical Utilisation of Computed Tomography of the Scaphoid. Hand Surg 1999; 4 (1) 3-9
    CrossrefPubMedGoogle Scholar